Dr. Patrick Soon-Shiong, Co-Chair of the Bipartisan Policy Center’s CEO Council

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: W ell Margaret, the employer mandate may have been given a
reprieve by the Obama Administration for a year bu t it survived a challeng e in
court that sought to have it overturned.

Margaret Flinter: That’s right , Mark . A federal appeals court rejected a lawsuit
over the employer mandate as well as the individual mandate . The lawsuit was
filed by Liberty Univers ity . That’s the one founded by Reverend Jerry Falwell ,
who also s ought to over turn the law ’ s contraception requirement.

Mark Masselli: The court rejected the claim that the employer mandate was
unconstitutional .

Margaret Flinter: But I expect Mark tha t there will be many more legal challenges
before we are through . Certainly the attorneys for Liberty University , we
understand , are planning an appeal , and as many guests on our show ha ve told
us, the health care law is likely to be under attack from var ious legal points of
view for sometime to come.

Mark Masselli: And of course , the employer mandate was already a hot button
issue after the Obama Administration announced they would delay the employer
mandate requirement of the Affordable Care Act until 2015 , giving companies
with 50 or more employees one year reprieve before being required to provide
health insurance for their employees.

Margaret Flinter: That’s right , Mark . And the Obama Administration and officials
at HHS want to make sure that ther e is a safe and reliable secure infrastructure
in place for reporting that employee insurance information to the IRS and I think
they just decided it was better to wait and get it right.

Mark Masselli: So as unwieldy as it is getting the health care law of f the ground ,
there are efforts underway in other sectors seeking to improve health care in th is
country . The Bipartisan Policy Center just announce d a new initiative.

Margaret Flinter: The CEO Council on Health and Innovation is bringing together
som e of th e nation ’ s most powerful CEOs to combine their efforts to improve
strateg ies and practices fo r improving employee health and wellness efforts they
hope will have a positive effect on health care delivery and c osts .

Mark Masselli: Our guest today i s the co - chair of the CEO Council . Dr. Patrick
Soon - Shiong is a physician , entrepreneur and CEO of several foundations

dedicated to improving health care deliver y. He is telling us about the CEO
Council to improve health care .

Margaret Flinter: And our FactCheck.org Managing Editor Lori Robertson looks
at an ad that’s been airing with some misleading information about the Affordable
Care Act . And no matter what the topic , you can hear all of our shows by
Googling CHC Radio .

Mark Masselli: And as alwa ys, if you have comments, e - mail us at
www.chcradio.com or find us on Facebook or twitter because we would love to
hear from you.
Margaret Flinter: We will get to our interview with Dr. Patrick Soon - Shiong in just
a moment.
Mark Masselli: But first here is our producer Marianne O'Hare, with this week’s
Headline News.
(Music) Marianne O'Hare: I am Marianne O 'Hare with these Health Care Headlines .
Another week in Congress , another vote to re peal the Affordable Care Act in the
wake of White House decision to delay the health care law ’ s employer mandate
for a year . Conservatives are jumping into the breach ; House Republicans will
vote this w eek to delay the part of Obamacare , requiring Americans to buy health
ins urance by next year , arguing that President Obama recently delayed the part
of the law requiring employers to offer health insurance. There have already
been 37 attempts to pass laws overturning the Affordable Care Act in the House.
And moving ever close r to full implementation of the law , more provisions are
coming to light . Folks who purchase the lower frills, silver or bronze plans on the
insurance exchanges will pay considerably more out of pocket for prescriptions ,
up to 34% more . For hundreds of t housands of primary care physicians across
the country , the era of unreimburse d evaluation and management or E& M c are ,
may finally be coming to an end . Recognizing care coordination may hold a key
to keeping health care costs in check for an aging populat ion .

The CMS last week proposed reimbursing doctors starting in 2015 for patient
care management activities that don’t involve face - to - face contact. Many of the
nation ’ s primary care advocates who had been demanding stepped up
reimbursement of their E&M activities including paying for phone calls and other activities that take place outside the ir traditional clinical setting , say the proposed
rule marks a major step in the right direction.
I am Marianne O'Hare, with t h e s e Health Care Headline s .

( Music)

Mark Masselli: We are speaking today with Dr. Patrick Soon - Shiong , physician,
scientist , entrepreneur and co - chair of the Bi p artisan Policy Center ’ s new CEO
Council on Health and Innovation, which is combined the efforts of CEOs from
some of the nation ’ s largest corporations to develop strategies that will improve
employees ’ health and wellness and lead to more cost effective health care . Dr.
Soon Shiong is the founder of numerous pharmaceutical entities and is
responsible for over 50 pate nts for groundb reaking drugs and medical
procedures. He is Chairman and CEO of the Institute for Advanced Health and
the Healthcare Transformation Institute . He also founded the National
Lambda R ail and NantWorks , LLC , whose mission is to conver ge semiconductor
technolo gy , supercomputing advance d networks , improving innovations to
revolutionize the health care delivery. Dr. Soon - Shiong , welcome to
conversations on Health Care .

Dr. Patrick Soon - Shiong: Thank you.

Mark Masselli: You kn ow , the Bi p artisan Policy Center just announced the
formation of a group that you are co - chair of , the CEO Council on Health and
Innovations , which f eatures CEOs from some of the most formidable companies
in the country . And the goal is to highlight innovative strategies that are going t o
improve the health and wellness of employees working for those large
corporations . You know , Margaret and I both have a good friend Mike Critelli
who was Chairman and CEO of Pitney Bowes . And we know when Mike was
CEO , he had a real passion for this ty pe of transformation in his setting . Tell us a
little bit about the collaboration that you have built and some of the key players
and the passion that really drives the team.

Dr. Patrick Soon - Shiong: So you mentioned Mike Critelli and he and Craig
Barre tt had created this organization called Dossia . And I helped support and
fund that organization many years ago and continue to , with the concept that
really the private sector and the large employers could significantly impact this
country by transforming health . And I had the good fortune to meet with
visionary leaders such as Muhtar Kent at Coca Cola and Lowell McAdam at
Verizon and Brian Moynihan at Bank of America , who had the very same
passion , wanting to make a real difference not only to the employ ees but to the
nation with regard to health care . So this council I think I honestly believe will be
one of the most important impactful organizations that will really drive action
rather than just a council for policy or as a think tank . I think we call ourselves a
d o tank.

Margaret Flinter: That’s great ; I like that.

Dr. Patrick Soon - Shiong: And these are very , obviously not any visionary
lead ers but operational lea d ers who run major corporations and see health care

as a crisis for our nation . And I am just honored and proud to be a part of this
organization with Mu htar , myself and the rest of the board.

Margaret Flinter: So Dr. Soon - Shiong , I think you might have just sa id that you
only had one meeting , so this may be premature and I think I unde rstand that the
CEO Council on Health and Innovation isn’t planning to issue a report on
strategies or best practices until next year. So what kind of strategies are you
planning to focus on , can you give us a glimpse into that, that look to have the
most potential for improving the health of the population and impacting health
care cost?

Dr. Patrick Soon - Shiong: No w very much so this team , meaning Lowell
McAdam , Brian Moynihan and Muhtar Kent, we have been working together as
long as two to three years ago . Let me give you little bit of the history . About
four years ago , I met with Brian Moynihan at Bank of America with a concept that
collectively we needed to create an infrastructure in this nation for a fiber
infrastructure , such that information sha ring could occur to address not only
chronic diseases but things important like cancer . And then I met with Lowell
McAdam at the Verizon level and we participated toget her in the World Congress
o n Health and we found the same passion. And then I met with Muhtar Kent who
is doing amazing things on a global basis for the world. And so over the course
of the last two years , we have actually quietly implemented tiny little pilots inside
our own organizations. And what I am excited to say is that the impleme ntation
is actually moving forward in real time as we speak , a nd th e CEO Council is the
first public announcement so to speak.

Mark Masselli: Talk a little bit about the sort of thematic themes that are
embedded in the Affordable Care Act and serve the T riple Aim of it i mproving
access , outcomes and containing cost . And they seem to align with your own
group ’ s efforts as well. Can you tell us about the sort of three - pronged approach
that’s be ing use d by the CEO Council to improve health and wellness of
employees and how it aligns with the goals of the Affordable Care Act ?

Dr. Patrick Soon - Shiong: The first thing is to look at the patient . And really , we
are looking at not just wellness but also illness. So we address this concept that
we need to figu re out a way to manage the patients in the continuum of the entire
life w hen they are well but on the other hand , when they are desperately ill , then
there is this whole area of am I getting the right treatment , what's the best care.
Then there is a third element that’s in between when they have the hypertension,
asthma, diabetes, obesity , and what we call willingness . So you have wellness
willingness and illness . And the mission of the council is to address th at entire
continuum of wellness, willingness and illness. Muhtar at the council meeting
put it really well where he said we need to address as the council and the private
sector are the ones that are actually going to be able to do this much faster than
the government can.

So the mission of the Co uncil is to implement innovative strategies to take
advantage of the wireless technology and advanced computing and the Cloud
technology that currently exist s today and apply that. So we have implemented
strategies that unfortunately can only be done with areas of speed and
implementation between the private sector , the nonprofit sector and philanthropic
sector, and then finally , the NGOs and the government . And that’s why people
like Ray Chamber s was invited with Special Envoy to the United Nations. So this
is very much a n implementation council of actually testing and validating
technologies at large scales s o that it could be implemented across this country
but also be used on a global basis. The Council is to look at health care delivery
systems, to address coordinated care , to address wellness programs that are
real and measurable and to address illness programs where we take advantage
of the genome and the proteome that’s going to enter in all areas of care.

Margaret Flinter: Well Dr. Soon - Shiong , I think you have laid out a compelling
vision and we know that there has been so much innovation over the last decade
I would say around strategies to change behavior , some big improvements in
technology still meeting up against of course the human factor s. We would really
be interested hearing about some of the specific strategies and what the
breakthrough is in the thinking or the implementation or the innovation.

Dr. Patrick Soon - Shiong: So we always invited the thought leaders both on the
provider l evel , people like provider of health system such as Providence and
Dignity . We also invited American Cancer Society and societies such as the
pediatrics and primary care physicians , etc. I think the issue is let's talk about
cancer for example . I don’t think what people realize in our country now we have
over 20 million cancer survivors and there is two million cancer new diagnos e s a
year. I think not many people realize th e sad statistic and th at is 40,000 patients
with breast biopsies a year that are r ea d for the wrong patient , 20,000 prostate
biopsies a year that are r ea d f o r the wrong patient . Would it be acceptable for
example that we now know from 2001 to 2005 that patients with pancreatic
cancer receive d the wrong treatment 65% of the time ?

I th ink these are the kind of statistics that are not only unacceptable , it’s
unconscionable that we not address. So we ask ourselves how is it possible for
us ever to be able to bend the cost curve or even get the best care when we are
spending more than any other country in the world and ranking lowest on the
tables. And the question is very simple , how c ould we ever hope for example in
cancer to bend the cost curve and get the right treatment w hen we don’t know
what the right treatment is to be given befor e treatment begins ? If you have
pancreatic cancer , the dogma is that you have a standard of care which is the
current standard of care which is a single drug which is on the market. The
survival rate is maybe two months to six months . Yet, if we w ere to tell you that if
in fact you had the correct treatment and the correct molecular profile , the
opportunity for you to be free of disease , completely free of disease and be alive

five years out , and in fact we say we now have multiple patients with that exa ct
statistic.

So this is the challenge that there is no such thing that I call a national
information highway and the interoperable system that for the first time connects
not only the knowledge base of the nation and the collective wisdom of the nation
t o the delivery system b ut also connects the delivery system to the payment
system. On the knowledge system , we are making such amazing breakthroughs
and we will make more scientific technical biological breakthroughs in the next
five years than we made in the last 50 years based on the genom ic and
proteomic science. But that information will not enter into the delivery system ; it
may take 10 to 17 years to enter the delivery system. But that’s unacceptable
when you are dying of pancreatic cancer or any c ancer or any chronic disease
that you could have a different outcome if in fact that knowledge was in the
hands of the delivery system.

When you go to the delivery system , there is a total disconnect and absence of
any coordination of care. When you come to the payment system , the only way
the providers are incented is to do as much procedures as possible because it's
a fee for service base d system. There is no ICD - 9 code for healthy . The only
way the nurses , the doctor s, the providers get incented is t o wait until you get to
the emerg ency room and do as many procedures as possible. So then if you
look at the knowledge system , the delivery system and the payment system ,
these barriers between these three create such a non - system of care , it's no
wonder we spend $4 trillion and have no way of ac countable value base d care ,
no way of measuring outcomes . That’s the strategy we have taken in the last 5
years to b uild an infrastructure across this nation that you would then tie the
knowledge system to the del ivery system , and insi de the delivery system , you
would create a coordination of care and then tie that to the payment system so
that the payment system incen ts he alth rather than illness . And I think the C E O
Council now finally reaches the payment bucket where one of the opportunities
for the CEO Council is to completely change the payment system and to incent
the providers or a healthy human being rather than react to treatment for illness.

Mark Masselli: We are speaking today with Dr. Patrick Soon - Sho ing , a
physician , scientist , entrepreneur and co - chair of the Bipartisan Policy Center ’s
new CEO Council on Health and Innovation, which is seeking collaboration
among some of the nation ’ s largest corporations to develop strategies that will
improve employ ees ’ health and wellness and lead to more cost effective health
care. You have been talking about this knowledge network that works with the
delivery system and the payment system, and I wonder if the delivery system
isn't at the heart of the problem here and whether or not you are employing some
change management techniques. How are you thinking about change
management when you are thinking about the delivery system because it's sort
of a radical redesign that’s needed ?

Dr. Patrick Soon - Shiong: So chan ge management is incredibly important but
nothing motivates more than change management by incenting payment to adopt
the change. On the delivery system itself , you are completely correct. The
greatest fear I had when the Health Information Technology Pr ogram was
launch ed was that we would build what we call medical bridges to nowhere. But
the software systems totally prevent interoperability ; it totally prevents information
of activity on a day - to - day basis. The only way that we would absolutely be abl e
to get true care coordination and population management is have the capability
of a patient when the patient is at home or the patient is in the clinic o r the
community hospital o r the doctor or i n the t ertiary enter and then back at home
with continuous information exchange of real time clinical data at the fingertips of
both the patients and the provider . That technology and that interoperable
system did not exist.

And so I presented myself six or seven years ago to Dossia and said, we as
leaders need to create this infrastructure for the United States . That is why I took
on the National LambdaRail . The National LambdaRail is a fibr e infrastructure
that ’s (17:5 3 inaudible). So if one could then take technology that currently exist s
today and then th e magic of what we call machine - to - machine learning wireless
technology , whereby vital signs could be monitored directly out of the machines
whether it be blood pressure machine , a ventilator machine , and then we
integrate that data continuously into the C loud with all the clinical labs and the
imaging and tie that to the activity down to the activity level of whether it's a nurse
practitioner, whether it's a doctor , physician ’s assistant and provide them both
transparency and clarity of treatment and then be able to monitor the outcomes
in real time a nd adaptively change and create continuous learning systems
across the continuum throughout the nation , we will then truly transform this care.

So I presented this plan around 2008 to the Institute of Medicine at the National
Library of Medicine to initiate this i n the country. And unfortunately , I could not
get the govern ment agencies to adopt this. So we then left out on our own and
created the Institute of Advanced Health, and partnered now with the large
employe r s of the nation. And let me share with me now , with excitement , where
we are. We have through a Software as a Service in the Cloud now deploy ed
this decision tool amongst 8000 oncol ogists as we speak today. And the
insurance companies have now b een given a tool to approve the payment and
know in real time before treatment begins that the patient and the doctor is
getting the right evidence - based treatment. If we can then capture the vital signs
of a human being in a hospital and at home , regardl ess of what machine , what
medical device , we have created APIs that can m e ssage and talk to every one of
these medical devices.

This year , we will be capturing three billion vital signs across the United States s o
that these vital signs w ill self - pollute the electronic medical record regardless of
what the electronic medical record is , whether it's a (19:56 inaudible) . And now
you have vital signs that could be captured in the Cloud. Now , if you can now tie

that information across the continuum from the patient , when the patient goes to
the clinic , with a software system that actually captures the activity and cost in
real time , if you can then interconnect that to imaging of CAT scans -- there is a
study that CAT scan ’s higher radiation c auses cancer in children. But if you
could take these CAT scans and PET scan s and put the data into supercomputer
and then stream the results so that instead of just 64 slice images or 120 slice
images you have a million images because it's every second of the data , you
then have a way of creating image in the Cloud down to the patient. We now
have this deployed place s like Cleveland Clinic and Mount Sinai . We recognize
that all the information we ultimate ly need will come out of a blood test , a nd a
blood test will be t he genom ics but not just genom ics but leapfrogging to
proteomics .

You need then a super computer to manage this kind of analysis because this
kind of analysis right now takes 11 weeks to do for one patient . So that’s why we
b uilt a supercomputer that has now taken 6000 human genomes, 3000 patients
and computed that complete analysis in 69 hours. That translates to the fact that
we can no w complete the analysis for one patient in 47 seconds. The vital signs
have to be captured remotely from machine to ma chine and self - populate your
data , and the decision support tools data is all evidence - based. All of a sudden
we have a real learning system that is totally scalable and that’s the strategy that
we have been deploying and that’s a strategy we can deploy a cross this nation
through the CEO Council .

Margaret Flinter: We have been speaking today with Dr. Patrick Soon - Shiong ,
physician , entrepreneur co - chair of the Bi p artisan Policy Center ’s new CEO
Council on Health and Innovation . You can learn more about the Bi p artisan
Policy Center ’ s Council on Health and Innovation by going to
www.bipartisapolicy.org and you can follow him on Twitter a t Solvehealthcare.
Dr. Soon - Shiong , thank you so much for joining us on Conversations on Health
Care today.
Dr. Patrick Soon - Shiong: Thank you.
(Music) Mark Masselli: At Conversations on Health Care, we want our audience to be truly in the know when it comes to the facts about health care reform and policy. Lori Robertso n is an award - winning journalist and Managing Editor of
FactCheck.org , a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this week? Lori Robertson: Well the ad wars over the Affordable Care Act continue . The
latest is an ad from a conservative group that poses misleading questions about the law . In this one , a mother named Julie asks if we can ’t pick our own doctor ,

how do I know my family is going to get the c are they need . But the law doesn’t
prohibit Julie from picking her own doctor. Julie goes on to ask , can I really trust
the folks in Washington with my famil y’ s health care . But despite many claims to
the contrary , the government isn’t taking over the h ealth care system or getting
involved in families ’ health care decision making. We ask ed the group behind
the ad , Americans for Prosperity, about the claim that families won't be able to
pick their own doctor. The spokesman told us that the ad is actuall y referring to
some individuals l osing their insurance and having limited choices in other
insurance plans. The nonpartisan Congressional Budget Office does predict that
7 million fewer workers net will get their insurance t hrough their jobs in 2023
becau se of the law. But will they face a narrow network of providers getting their
insurance elsewhere ? Possibly . Some insurance plans on state - bas ed
ex changes are offering a smaller network o f providers in order to keep the
premium cost down. But the 7 mil lion losing an offer of job - based coverage is a
small percentage of the 160 million that are expected to have such insurance.
The law can ’t guarantee th at folks can keep their current doctor. Employers are
free to switch plans and workers are free to swi tch jobs just as they were before
the law was passed . And that’s my fact check for this week. I am Lori
Robertson, Managing Editor of FactCheck.org , here on ReachMD .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s ma jor political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com . We will have FactCheck. org ’s Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Margaret Flinter: This is Conversations on Health care. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Health Care, broadcast from the campus of WESU at Wesleyan University, streaming live at

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